Provider Demographics
NPI:1477518959
Name:ULLAND, BRADLEY JAMES (OD)
Entity Type:Individual
Prefix:DR
First Name:BRADLEY
Middle Name:JAMES
Last Name:ULLAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 32ND AVE S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5800
Mailing Address - Country:US
Mailing Address - Phone:701-234-3640
Mailing Address - Fax:701-234-8710
Practice Address - Street 1:2400 32ND AVE S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-5800
Practice Address - Country:US
Practice Address - Phone:701-234-3640
Practice Address - Fax:701-234-8710
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND371152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND60298Medicaid
ND60723Medicaid
ND711544Medicare ID - Type Unspecified
ND60723Medicaid